1H-1,2,3-triazol-1,4-naphthoquinone Derivatives: Novel Inhibitors Targeting Pyocyanin Biosynthesis for P. Aeruginosa Infection Treatment Advances.

BACKGROUND: This study investigates the potential of eleven 1H-1,2,3-triazol-1,4-naphthoquinone conjugates as virulence factor inhibitors (like Pyocyanin) and their affinity for PhzM, a crucial enzyme for Pyocyanin biosynthesis in Pseudomonas aeruginosa infections. METHODS: A straightforward synthetic pathway enabled the production of these compounds, which were characterized and structurally confirmed through spectroscopic analyses. Evaluation of their impact on PhzM thermal stability identified promising candidates for PhzM binders. RESULTS: Concentration-response behavior elucidated their binding affinity, revealing them as the first reported micromolar affinity ligands for PhzM. Structure-activity relationship analysis emphasized the role of specific molecular moieties in binding affinity modulation, paving the way for future advanced inhibitors' development. CONCLUSION: These findings highlight the potential of naphthoquinone-triazole derivatives as leads for novel therapeutics against P. aeruginosa infections.

Synthesis, design, and optimization of a potent and selective series of pyridylpiperazines as promising antimalarial agents.

An optimization of the pyridylpiperazine series against Plasmodium falciparum has been performed, exploring a structure-activity relationship carried out on the toluyl fragment of hit 1, a compound with low micromolar activity against Plasmodium falciparum discovered by high-throughput screening. After confirming the crucial role played by this aryl fragment in the antiplasmodial activity, the replacement of the ortho-methyl substituent of 1 by halogenated ones led to an improvement for four analogs, either in terms of potency, expected pharmacokinetics profile, or both. Further introduction of endocyclic nitrogens in this fragment identified two more optimized compounds, 20 and 23, which are expected to be much more metabolically stable than 1. Additional assessment of the cytotoxicity, Ligand Lipophilic Efficiency, potency against the chloroquine-resistant Dd2 strain and in silico ADMET predictions revealed a satisfactory profile for most compounds, ultimately identifying the four optimized compounds 7, 9, 20 and 23 as promising compounds for further lead optimization of this series against Plasmodium falciparum.

Percepção dos médicos sobre reuniões entre níveis de atenção em uma rede municipal de saúde de Pernambuco, Brasil / Doctors' perception of meetings between levels of care in a municipal health network in Pernambuco, Brazil

O estudo analisa a percepção de médicos da atenção primária(AP)e especializada (AE) sobre a intervenção Reuniões Conjuntas entre Níveis de Atenção em uma rede municipal de saúde de Pernambuco, Brasil. Estudo avaliativo realizado por meio de entrevistas com 86 médicos. Utilizou-se análise univariada e bivariada dos dados. Os resultados demonstraram que79,2%dos profissionais da APe 20,8%da AE referiram ter conhecimento sobre o componente Linha de Cuidado em Diabetes, enquanto73,5% AP e26,5%AEsobre Discussão Conjunta de Casos em Saúde Mental. O principal motivo para utilização da linha de cuidado para profissionais da AP foi dar bom atendimento ao paciente (43,3%), enquanto os da AE referiram padronização da atenção e acompanhamento ao paciente (43,8%). Dificuldades referidas: deficiências dos serviços, realização do apoio diagnóstico e seguimento do tratamento. Verificaram-se percentuais mais elevados quanto à confiança e colaboração na perspectiva dos profissionais da AP. Entretanto, pouco mais de um terço dos médicos afirmaram conhecer o profissional do outro nível de atenção. Os resultados demonstram que a intervenção foi percebida como fundamental para melhoria da articulação e cooperação entre AP e AE com fomento ao desenvolvimento da percepção da forma de atuação e implicação dos profissionais nesse processo.

The studyanalyzes the perception of doctors in primary(PC)and secondary care(SC)about the intervention Joint Meetings between Health Care Levels in a municipal health care network of Pernambuco, Brazil. Evaluative studycarried out through interviews with 86 doctors. Univariate and bivariate data analysis was performed. Results demonstrated that 79.2% of PC professionals and 20.8% of SC reported knowledge about Diabetes Shared Care Guidelinescomponent, while 73.5% PC and 26.5% SC about Joint Discussions of Clinical Cases in Mental Health. According to PC professionals, the main reason to using the care guidelines was to provide good patient care (43.3%) whilst standardization of care and patient follow-up (43.8%) were reported by the SC professionals. As difficulties: deficiencies in services, exams and continuity of treatment.Higher percentages related to trust and collaboration in the perspective of PC professionals were achieved. However, near a third of doctors referred to know the professional at the other level of care. The results demonstrate that the intervention was perceived as essential to improving articulation and cooperation between PC and SC towards a perception development of the performance way and professionals' involvement in this process.

Relational Continuity of Chronic Patients with Primary and Secondary Care Doctors: A Study of Public Healthcare Networks of Six Latin American Countries.

Despite relational continuity (RC) with the doctor being key to care quality for chronic patients, particularly in fragmented healthcare systems, like many in Latin America (LA), little is known about RC and its attributes, particularly regarding specialists. Aim: We aim to analyse chronic patients' perceptions of RC with primary (PC) and secondary (SC) care doctors, and record changes between 2015 and 2017 in the public healthcare networks of six LA countries. An analysis of two cross-sectional studies applying the CCAENA questionnaire to chronic patients (N = 4881) was conducted in Argentina, Brazil, Chile, Colombia, Mexico, and Uruguay. The dependent variables of RC with PC and SC doctors were: consistency, trust, effective communication, and synthetic indexes based on RC attributes. Descriptive and multivariate analyses were performed. Although the RC index was high in 2015, especially in PC in all countries, and at both levels in Argentina and Uruguay, low perceived consistency of PC and SC doctors in Colombia and Chile and of SC doctors in Mexico revealed important areas for improvement. In 2017 the RC index of SC doctors increased in Chile and Mexico, while SC doctors' consistency in Colombia decreased. This study reveals important gaps in achieving RC with doctors, particularly in SC, which requires further structural and organisational reforms.

Effects of Metacontingencies on Cooperative Behavior: A Systematic Replication Using Innovative Procedures during Isolation.

The study replicated research on metacontingencies that used a chessboard simulating a simplified chess game, in a completely online environment, with participants in their homes. Dyads of participants had to work together moving two knights in L-shape. Each trial ended when the knights met in adjacent squares. The squares where the knights should meet (aggregate product [AP]) varied in two conditions, using an ABAB design. In conditions A, knights should meet anywhere on the chessboard, and there was no consequence. In conditions B, the matrix of reinforceable squares was gradually reduced in four phases and knights' encounters were followed by different messages when correct or incorrect (cultural consequences). In group 1, five dyads were allowed to communicate. In group 2, dyads had no access to video call. Results of group 1 corroborate the findings of the original studies that showed a decrease in APs variability from conditions A to B, when communication was allowed. Group 2 showed similar results, therefore extending to the setting that not allowed communication. The online platform XadrezWeb, developed for this study, was an important tool to program the interlocked behavior contingencies and collect data during social isolation.

Do Body Mass Index Levels Correlate with Tinnitus Among Teachers?

Abstract Introduction Working conditions can contribute to the development of lifestylerelated diseases among teachers, including obesity and tinnitus. Describing tinnitus in relation to characteristics and comorbidities can help the treatment and prognosis of teachers affected by this symptom. Objective To verify a possible association between tinnitus complaint and body mass index (BMI) in teachers. Methods Cross-sectional study with a sample of teachers who responded to the Visual Analog Scale (VAS) and to the Tinnitus Handicap Inventory (THI). The BMI (kg/m2) was calculated based on self-reported body weight (in kilograms) divided by height (in meters squared). Nonparametric statistics were applied adopting a significance level < 0.05 Results A total of 83 teachers were assessed, with a mean age 48 ± 9.7 years old; 63.9% (n= 53) were females; 44.6% were eutrophic (n = 37), and 16.9% (n = 14) were obese. Of the total, 19.3% (n = 16) reported tinnitus. No differences were found between the groups and BMI (p > 0.05), although there was a significant difference between the Tinnitus and No Tinnitus groups for age (p < 0.001). The chi-squared test showed an association between age group and tinnitus (p < 0.028); those with tinnitus were in the 49 to 65 years old age group. In addition, there was a moderate correlation between tinnitus parameters (VAS; THI-Functional; THI-Total) and BMI. Conclusion There was a moderate correlation between tinnitus parameters and BMI indicating that, as the BMI increased, so did the impact of tinnitus in the lives of the teachers. Body mass index should be considered a factor in tinnitus assessment and rehabilitation process.

Do Body Mass Index Levels Correlate with Tinnitus Among Teachers?

Introduction Working conditions can contribute to the development of lifestyle-related diseases among teachers, including obesity and tinnitus. Describing tinnitus in relation to characteristics and comorbidities can help the treatment and prognosis of teachers affected by this symptom. Objective To verify a possible association between tinnitus complaint and body mass index (BMI) in teachers. Methods Cross-sectional study with a sample of teachers who responded to the Visual Analog Scale (VAS) and to the Tinnitus Handicap Inventory (THI). The BMI (kg/m2) was calculated based on self-reported body weight (in kilograms) divided by height (in meters squared). Nonparametric statistics were applied adopting a significance level < 0.05 Results A total of 83 teachers were assessed, with a mean age 48 ± 9.7 years old; 63.9% ( n = 53) were females; 44.6% were eutrophic ( n = 37), and 16.9% ( n = 14) were obese. Of the total, 19.3% ( n = 16) reported tinnitus. No differences were found between the groups and BMI ( p > 0.05), although there was a significant difference between the Tinnitus and No Tinnitus groups for age ( p < 0.001). The chi-squared test showed an association between age group and tinnitus ( p < 0.028); those with tinnitus were in the 49 to 65 years old age group. In addition, there was a moderate correlation between tinnitus parameters (VAS; THI-Functional; THI-Total) and BMI. Conclusion There was a moderate correlation between tinnitus parameters and BMI indicating that, as the BMI increased, so did the impact of tinnitus in the lives of the teachers. Body mass index should be considered a factor in tinnitus assessment and rehabilitation process.

Assessing the impact of clinical coordination interventions on the continuity of care for patients with chronic conditions: participatory action research in five Latin American countries.

Although fragmentation in the provision of services is considered an obstacle to effective health care, there is scant evidence on the impact of interventions to improve care coordination between primary care and secondary care in terms of continuity of care-i.e. from the patient perspective-particularly in Latin America (LA). Within the framework of the Equity-LA II project, interventions to improve coordination across care levels were implemented in five Latin American countries (Brazil, Chile, Colombia, Mexico and Uruguay) through a participatory action research (PAR) process. This paper analyses the impact of these PAR interventions on the cross-level continuity of care of chronic patients in public healthcare networks. A quasi-experimental study was performed with measurements based on two surveys of a sample of patients with chronic conditions (392 per network; 800 per country). Both the baseline (2015) and evaluation (2017) surveys were conducted using the CCAENA questionnaire. In each country, two comparable public healthcare networks were selected, one intervention and one control. Outcomes were cross-level continuity of information and clinical management continuity. Descriptive analyses were conducted, and Poisson regression models with robust variance were fitted to estimate changes. With differences between countries, the results showed improvements in cross-level continuity of clinical information (transfer of clinical information) and clinical management continuity (care coherence). These results are consistent with those of previous studies on the effectiveness of the interventions implemented in each country in improving care coordination in Brazil, Chile and Colombia. Differences between countries are probably related to particular contextual factors and events that occurred during the implementation process. This supports the notion that certain context and process factors are needed to improve continuity of care. The results provide evidence that, although the interventions were designed to enhance care coordination and aimed at health professionals, patients report improvements in continuity of care.

Introdução alimentar: cartilha de orientações aos pais / Food introduction: guidebook for parents

Vocês estão recebendo a cartilha introdução alimentar, para orienta-los quanto a escolha adequada dos alimentos complementares ao aleitamento materno, para bebês a partir dos seis meses. Essa fase é muito importante para a formação dos hábitos saudáveis, é nesse momento que a criança passa a conhecer a infinidade de sabores que a acompanharão por toda a vida. Visando melhorar a qualidade de vida de nossas crianças, apresentamos esta cartilha que tem como objetivo, orientar os pais, familiares e cuidadores, quanto as escolhas alimentares mais saudáveis, garantindo assim, crescimento e desenvolvimento adequados às crianças.

The thinking and acting of health professionals on the coordination between the assistance levels of the health care network. / O pensar e o agir de profissionais de saúde sobre a coordenação entre os níveis assistenciais da rede de atenção à saúde.

The study aims to understand the thinking and acting of health professionals about the coordination between levels of care. Qualitative research from an international multicenter study Equity-LA II. Audios were retrieved from eleven interviews of doctors/nurses of two levels of care in Recife, 2014. A content analysis of the theoretical framework of coordination was performed in the light of the hermeneutic approach. Most professionals knew the duties of coordination, without identifying its execution. The primary care physician was not recognized as responsible for the clinic, nor for his role by the specialist physician, while the primary care physician resented it. Failures in the use/completion of reference/counter-reference mechanisms and organizational barriers emerged. The unavailability for the "conversation game" and "fusionality" was evidenced in the lack of recognition of authority in the authoritative character of the primary care physician by that of the specialized, feeling of less value for that and technicist and specialized posture in everyone's practice. The coordination in on professionals' view revealed the "there-to-be-understood" condition that needs to be launched in the "game of comprehension" to build dialogical practices focused on integral care.

O estudo objetiva compreender o pensar e o agir dos profissionais de saúde sobre a coordenação entre níveis assistenciais. Pesquisa qualitativa oriunda de estudo multicêntrico internacional Equity-LA II. Reescutaram-se áudios de onze entrevistas de médicos/enfermeiras de dois níveis assistenciais no Recife, 2014. Realizou-se análise de conteúdo do referencial teórico da coordenação à luz da abordagem hermenêutica. A maioria dos profissionais conhecia as atribuições da coordenação, sem identificar sua execução. O médico da atenção primária não foi reconhecido como responsável clínico, nem quanto ao seu papel pelo médico da atenção especializada, enquanto o da atenção primária ressentia-se. Emergiram falhas no uso/preenchimento dos mecanismos de referência/contrarreferência e entraves organizacionais. A indisponibilidade para o "jogo da conversação" e "fusionalidade" evidenciou-se no não reconhecimento da autoridade no caráter autoritativo do médico da atenção primária pelo da especializada, sentimento de menos valia daquele e postura tecnicista e especializada na práxis de todos. A coordenação no olhar dos profissionais revelou a condição "aí-a-ser-compreendido" carecendo se lançar no "jogo da compreensão" para construir práticas dialógicas voltadas ao cuidado integral.

O pensar e o agir de profissionais de saúde sobre a coordenação entre os níveis assistenciais da rede de atenção à saúde / The thinking and acting of health professionals on the coordination between the assistance levels of the health care network

Resumo O estudo objetiva compreender o pensar e o agir dos profissionais de saúde sobre a coordenação entre níveis assistenciais. Pesquisa qualitativa oriunda de estudo multicêntrico internacional Equity-LA II. Reescutaram-se áudios de onze entrevistas de médicos/enfermeiras de dois níveis assistenciais no Recife, 2014. Realizou-se análise de conteúdo do referencial teórico da coordenação à luz da abordagem hermenêutica. A maioria dos profissionais conhecia as atribuições da coordenação, sem identificar sua execução. O médico da atenção primária não foi reconhecido como responsável clínico, nem quanto ao seu papel pelo médico da atenção especializada, enquanto o da atenção primária ressentia-se. Emergiram falhas no uso/preenchimento dos mecanismos de referência/contrarreferência e entraves organizacionais. A indisponibilidade para o "jogo da conversação" e "fusionalidade" evidenciou-se no não reconhecimento da autoridade no caráter autoritativo do médico da atenção primária pelo da especializada, sentimento de menos valia daquele e postura tecnicista e especializada na práxis de todos. A coordenação no olhar dos profissionais revelou a condição "aí-a-ser-compreendido" carecendo se lançar no "jogo da compreensão" para construir práticas dialógicas voltadas ao cuidado integral.

Abstract The study aims to understand the thinking and acting of health professionals about the coordination between levels of care. Qualitative research from an international multicenter study Equity-LA II. Audios were retrieved from eleven interviews of doctors/nurses of two levels of care in Recife, 2014. A content analysis of the theoretical framework of coordination was performed in the light of the hermeneutic approach. Most professionals knew the duties of coordination, without identifying its execution. The primary care physician was not recognized as responsible for the clinic, nor for his role by the specialist physician, while the primary care physician resented it. Failures in the use/completion of reference/counter-reference mechanisms and organizational barriers emerged. The unavailability for the "conversation game" and "fusionality" was evidenced in the lack of recognition of authority in the authoritative character of the primary care physician by that of the specialized, feeling of less value for that and technicist and specialized posture in everyone's practice. The coordination in on professionals' view revealed the "there-to-be-understood" condition that needs to be launched in the "game of comprehension" to build dialogical practices focused on integral care.

Synthesis and biological evaluation of thiazolidinedione derivatives with high ligand efficiency to P. aeruginosa PhzS.

The thiazolidinone ring is found in compounds that have widespan biology activity and there is mechanism-based evidence that compounds bearing this moiety inhibit P. aeruginosa PhzS (PaPzhS), a key enzyme in the biosynthesis of the virulence factor named pyocyanin. Ten novel thiazolidinone derivatives were synthesised and screened against PaPhzS, using two orthogonal assays. The biological results provided by these and 28 other compounds, whose synthesis had been described, suggest that the dihydroquinazoline ring, found in the previous hit (A- Kd = 18 µM and LE = 0.20), is not required for PaPzhS inhibition, but unsubstituted nitrogen at the thiazolidinone ring is. The molecular simplification approach, pursued in this work, afforded an optimised lead compound (13- 5-(2,4-dimethoxyphenyl)thiazolidine-2,4-dione) with 10-fold improvement in affinity (Kd= 1.68 µM) and more than 100% increase in LE (0.45), which follows the same inhibition mode as the original hit compound (competitive to NADH).Executive summaryPhzS is a key enzyme in the pyocyanin biosynthesis pathway in P. aeruginosa.Orthogonal assays (TSA and FITC) show that fragment-like thiazolidinedione derivatives bind to PaPhzS with one-digit micromolar affinity.Fragment-like thiazolidinedione derivatives bind to the cofactor (NADH) binding site in PaPhzS.The molecular simplification optimised the ligand efficiency and affinity of the lead compound.

[Communicational relations between healthcare professionals and their influence on coordination of care]. / As relações comunicacionais entre os profissionais de saúde e sua influência na coordenação da atenção.

The study aims to understand the influence of communicational relations among healthcare professionals in the coordination of care between levels. This is a qualitative study with data from the international multicenter study Equity-LA II, with dialectic hermeneutics as the theoretical reference. The authors listened to the audios from 15 interviews with professionals (7 physicians from primary care and 5 from specialized care, and 3 institutional supporters from primary care) in a municipal network in the Agreste region of the state of Pernambuco, Brazil, in 2016. The mixed categories were submitted to content analysis. The analysis revealed a lack of recognition, by nearly all of the professionals, of primary care as the organizational backbone for care, and the perception of coordination revealed obstacles related to disconnects in establishing dialogical relations. Knowledge of the physician's role in primary care is incomplete, and its praxis is viewed with distrust by specialists, while the reciprocal is not true. There was a visibly non-dialogical interpersonal relationship, based on asymmetric relations reflected in the specialist's authoritarian stance and that of inferiority of primary care physicians. The basis for the communicative action relates to pretensions of validity rather than of power, which is external to language, and impedes the discussion of reasons and arguments. There was little disposition for dialogue and reciprocal recognition between the parties involved, with interdiction of a communicative situation in which there is symmetry of participation. The results revealed communicational weaknesses, thus requiring strategies that allow achieving communicative understanding among the professionals and promoting satisfactory patient follow-up between levels of care.

O estudo objetiva compreender a influência das relações comunicacionais entre os profissionais da rede de atenção à saúde na coordenação entre níveis assistenciais. Estudo qualitativo com dados de pesquisa multicêntrica internacional Equity-LA II, utilizando o referencial teórico da hermenêutica dialética. Escutaram-se áudios de 15 entrevistas a profissionais (7 médicos da atenção primária e 5 da atenção especializada e de 3 apoiadores institucionais da atenção primária) de uma rede municipal no agreste pernambucano, Brasil, em 2016. As categorias mistas foram submetidas à análise de conteúdo. Revelou-se o não reconhecimento da atenção primária como ordenadora do cuidado por quase todos os profissionais e a percepção sobre a coordenação do cuidado desvelou obstáculos relacionados aos desencontros em estabelecer relações dialógicas. O saber sobre o papel do médico da atenção primária é incompleto e sua práxis vista com desconfiança por especialistas, a recíproca não ocorrendo. Percebeu-se uma relação interpessoal não dialógica, pautada na relação assimétrica refletida na postura autoritária do especialista e de inferioridade dos médicos da atenção primária. A base do agir comunicativo refere-se às pretensões de validade e não de poder, que é externo à linguagem, e impossibilita a discussão de razões e argumentos. Evidenciou-se pouca disponibilidade ao diálogo e ao reconhecimento recíproco entre os envolvidos, com interdição da situação comunicativa, em que há simetria de participação. Os resultados revelaram fragilidades comunicacionais, sendo necessárias estratégias que permitam o alcance do entendimento comunicativo entre os profissionais, promovendo o seguimento satisfatório entre níveis assistenciais.

El objetivo del estudio fue comprender la influencia de las relaciones comunicacionales entre los profesionales de la red de atención a la salud en la coordinación entre niveles asistenciales. Estudio cualitativo con datos de investigación multicéntrica internacional Equity-LA II, utilizando el marco referencial teórico de la hermenéutica dialéctica. Se escucharon audios de 15 entrevistas a profesionales (7 médicos de la atención primaria y 5 de la atención especializada, y 3 profesionales de la atención primaria), en una red municipal en zona rural pernambucana, Brasil, en 2016. Las categorías mixtas se sometieron al análisis de contenido. Se reveló el no reconocimiento de la atención primaria como ordenadora del cuidado por casi todos los profesionales, y la percepción sobre la coordinación del cuidado desveló obstáculos relacionados con los desencuentros para establecer relaciones dialógicas. El saber sobre el papel del médico de la atención primaria es incompleto y su praxis vista con desconfianza por especialistas, lo que no sucede recíprocamente. Se percibió una relación interpersonal no dialógica, pautada en la relación asimétrica, reflejada en la postura autoritaria del especialista y de inferioridad de los médicos de la atención primaria. La base de la actuación comunicativa se refiere a las pretensiones de validez y no de poder, que es externo al lenguaje, e imposibilita la discusión de razones y argumentos. Se evidenció la poca disponibilidad para el diálogo y reconocimiento recíproco entre los implicados, con prohibición de situaciones comunicativas donde existe simetría de participación. Los resultados revelaron fragilidades comunicacionales, siendo necesarias estrategias que permitan el alcance del entendimiento comunicativo entre los profesionales, promoviendo el seguimiento satisfactorio entre niveles asistenciales.

Manual com orientações para pacientes: cirurgias cardíacas com pós operatório imediato em UTI / Manual with guidelines for patients: cardiac surgeries with immediate postoperative period in the ICU

Preparamos este manual para que você fique por dentro de tudo que vai acontecer durante seu tratamento. Aqui você encontrará as rotinas e os cuidados necessários antes, durante e após a sua cirurgia, com todas as informações para passar por esse momento com tranquilidade. Fique atento aos documentos e exames necessários. Caso tenha alguma dúvida, entre em contato com o hospital!

Manual de orientações gerais e recomendações para otimizar o retorno às atividades após a alta hospitalar / Manual of general guidelines and recommendations to optimize the return to activities after hospital discharge

Esse manual foi desenvolvido com muito empenho e dedicação com o objetivo de dar orientações e sugerir recomendações para o retorno gradual e seguro do paciente às suas atividades de vida diária e rotina laboral após a alta hospitalar. Esperamos que o leitor compreenda a importância dessas orientações e recomendações, visando uma melhor qualidade de vida e evitar complicações e reinternações no futuro.

Atendimento odontológico em pacientes com covid-19 em Unidades de Terapia Intensiva / Dental care in patients with covid-19 in Intensive Care Units

Este manual é uma produção científica da Residência Multiprofissional em Saúde, com área de Concentração em Terapia Intensiva Adulto, da Secretaria Estadual de Saúde do Maranhão. O principal objetivo é orientar a equipe multiprofissional acerca dos cuidados necessários com a saúde bucal dos pacientes em Unidade de Terapia Intensiva, e discorrer sobre o Atendimento Odontológico em UTI em tempos de pandemia da Covid-19.

Manual de monitorização do volume prescrito e infundido em terapia nutricional enteral / Manual for monitoring the volume prescribed and infused in enteral nutritional therapy

Esse Manual foi elaborado com a intenção de orientá-lo, quanto a importância do controle do prescrito e infundido na terapia nutricional enteral. Contém informações bem simples e seguras e que abrange toda a equipe multiprofissional.

As relações comunicacionais entre os profissionais de saúde e sua influência na coordenação da atenção / Communicational relations between healthcare professionals and their influence on coordination of care / Las relaciones comunicacionales entre los profesionales de salud y su influencia en la coordinación de la atención

O estudo objetiva compreender a influência das relações comunicacionais entre os profissionais da rede de atenção à saúde na coordenação entre níveis assistenciais. Estudo qualitativo com dados de pesquisa multicêntrica internacional Equity-LA II, utilizando o referencial teórico da hermenêutica dialética. Escutaram-se áudios de 15 entrevistas a profissionais (7 médicos da atenção primária e 5 da atenção especializada e de 3 apoiadores institucionais da atenção primária) de uma rede municipal no agreste pernambucano, Brasil, em 2016. As categorias mistas foram submetidas à análise de conteúdo. Revelou-se o não reconhecimento da atenção primária como ordenadora do cuidado por quase todos os profissionais e a percepção sobre a coordenação do cuidado desvelou obstáculos relacionados aos desencontros em estabelecer relações dialógicas. O saber sobre o papel do médico da atenção primária é incompleto e sua práxis vista com desconfiança por especialistas, a recíproca não ocorrendo. Percebeu-se uma relação interpessoal não dialógica, pautada na relação assimétrica refletida na postura autoritária do especialista e de inferioridade dos médicos da atenção primária. A base do agir comunicativo refere-se às pretensões de validade e não de poder, que é externo à linguagem, e impossibilita a discussão de razões e argumentos. Evidenciou-se pouca disponibilidade ao diálogo e ao reconhecimento recíproco entre os envolvidos, com interdição da situação comunicativa, em que há simetria de participação. Os resultados revelaram fragilidades comunicacionais, sendo necessárias estratégias que permitam o alcance do entendimento comunicativo entre os profissionais, promovendo o seguimento satisfatório entre níveis assistenciais.

The study aims to understand the influence of communicational relations among healthcare professionals in the coordination of care between levels. This is a qualitative study with data from the international multicenter study Equity-LA II, with dialectic hermeneutics as the theoretical reference. The authors listened to the audios from 15 interviews with professionals (7 physicians from primary care and 5 from specialized care, and 3 institutional supporters from primary care) in a municipal network in the Agreste region of the state of Pernambuco, Brazil, in 2016. The mixed categories were submitted to content analysis. The analysis revealed a lack of recognition, by nearly all of the professionals, of primary care as the organizational backbone for care, and the perception of coordination revealed obstacles related to disconnects in establishing dialogical relations. Knowledge of the physician's role in primary care is incomplete, and its praxis is viewed with distrust by specialists, while the reciprocal is not true. There was a visibly non-dialogical interpersonal relationship, based on asymmetric relations reflected in the specialist's authoritarian stance and that of inferiority of primary care physicians. The basis for the communicative action relates to pretensions of validity rather than of power, which is external to language, and impedes the discussion of reasons and arguments. There was little disposition for dialogue and reciprocal recognition between the parties involved, with interdiction of a communicative situation in which there is symmetry of participation. The results revealed communicational weaknesses, thus requiring strategies that allow achieving communicative understanding among the professionals and promoting satisfactory patient follow-up between levels of care.

El objetivo del estudio fue comprender la influencia de las relaciones comunicacionales entre los profesionales de la red de atención a la salud en la coordinación entre niveles asistenciales. Estudio cualitativo con datos de investigación multicéntrica internacional Equity-LA II, utilizando el marco referencial teórico de la hermenéutica dialéctica. Se escucharon audios de 15 entrevistas a profesionales (7 médicos de la atención primaria y 5 de la atención especializada, y 3 profesionales de la atención primaria), en una red municipal en zona rural pernambucana, Brasil, en 2016. Las categorías mixtas se sometieron al análisis de contenido. Se reveló el no reconocimiento de la atención primaria como ordenadora del cuidado por casi todos los profesionales, y la percepción sobre la coordinación del cuidado desveló obstáculos relacionados con los desencuentros para establecer relaciones dialógicas. El saber sobre el papel del médico de la atención primaria es incompleto y su praxis vista con desconfianza por especialistas, lo que no sucede recíprocamente. Se percibió una relación interpersonal no dialógica, pautada en la relación asimétrica, reflejada en la postura autoritaria del especialista y de inferioridad de los médicos de la atención primaria. La base de la actuación comunicativa se refiere a las pretensiones de validez y no de poder, que es externo al lenguaje, e imposibilita la discusión de razones y argumentos. Se evidenció la poca disponibilidad para el diálogo y reconocimiento recíproco entre los implicados, con prohibición de situaciones comunicativas donde existe simetría de participación. Los resultados revelaron fragilidades comunicacionales, siendo necesarias estrategias que permitan el alcance del entendimiento comunicativo entre los profesionales, promoviendo el seguimiento satisfactorio entre niveles asistenciales.

[Knowledge and use of clinical coordination mechanisms in healthcare networks in Latin America]. / Conocimiento y uso de mecanismos de coordinación clínica de servicios de salud de Latinoamérica.

OBJECTIVE: To analyze the level of knowledge and use, and the characteristics of use, of care coordination mechanisms in public healthcare networks of six Latin America countries. METHOD: Cross-sectional study based on a survey using the COORDENA® questionnaire with primary and secondary care doctors (348 doctors/country) of public healthcare networks in Argentina, Brazil, Chile, Colombia, Mexico and Uruguay (May-October 2015). Analyzed variables: degree of knowledge and use of information coordination (referral/reply letter, discharge report, phone, e-mail) and of clinical management coordination (shared clinical guidelines, joint meetings) mechanisms. Descriptive analyses were conducted. RESULTS: Knowledge of clinical information coordination mechanisms was high in both care levels and analyzed networks as was the use of referral/reply letter. There was greater variability in the use of discharge reports (from 40.0% in Brazil to 79.4% in Mexico) and, except for Argentina, a low reception reported by primary care doctors stands out (12.3% in Colombia and 55.1% in Uruguay). In contrast, knowledge of clinical management coordination mechanisms was limited, especially among secondary care doctors. It is noteworthy, however, that adherence to clinical guidelines was high (from 83.1% in Mexico to 96.8% in Brazil), while participation in joint meetings varied widely (from 23.7% in Chile to 76.2% in Brazil). The difficulties reported in the use of the mechanisms are related to structural and organizational factors. CONCLUSIONS: The limited knowledge and use of coordination mechanisms shows insufficient diffusion and implementation. Strategies to increase its use are needed, including the related factors.

Comparative study of sensation and repercussion of tinnitus on the quality of life and craniocervical posture in teachers / Estudo comparativo da sensação e repercussão do zumbido na qualidade de vida e postura craniocervical em professores

ABSTRACT Purpose: to verify whether there is a correlation between tinnitus sensation and repercussion on the quality of life and craniocervical posture in teachers, participating in the Pró-Mestre project. Methods: a cross-sectional study with a sample of 90 teachers, mean age of 47.70 years, who responded to the Craniocervical Dysfunction Index (CDI), to verify the craniocervical posture, the analog visual scale (AVS), and the Portuguese adaptation of the Tinnitus Handicap Inventory (THI), to investigate tinnitus and its impact on the quality of life. Appropriate statistical tests were applied, by adopting a significance level lower than 0.05. Results: out of the 90 teachers, 18 (20%) had tinnitus. There was a statistically significant difference between the sensation of tinnitus, according to the AVS and the craniocervical posture (CDI) in teachers (p <0.001). There was also an association between tinnitus complaint and right-rotation range of motion, with age and right lateral tilt being independent factors, regarding teachers' tinnitus sensation. In the correlation of the THI (total and domains), there was an association with cervical mobility, only in the left inclination. Conclusion: since a statistically significant difference was found between the subjective sensation of tinnitus and the craniocervical posture with a correlation between tinnitus sensation and repercussion on the quality of life and craniocervical posture in teachers, these aspects should be considered in the assessment of teachers presented with tinnitus, as well as further studies with a population of teachers, healthy adults, in order to increase the knowledge on the subject.

RESUMO Objetivo: verificar se existe correlação entre a sensação e repercussão do zumbido na qualidade de vida e postura craniocervical em professores. Métodos: estudo transversal com uma amostra de 90 professores participantes do projeto Pró-Mestre, com média de idade de 47,70 anos, que responderam ao Índice de disfunção Crânio cervical e a escala visual-analógica (EVA) e a adaptação para a língua portuguesa do Tinnitus Handicap Inventory (THI) para verificar o zumbido e sua repercussão na qualidade de vida. Foram aplicados os testes estatísticos pertinentes, adotando o nivel de significancia menor que 0,05. Resultados: dos 90 professores 18 (20%) apresentavam zumbido. Houve diferença estatisticamente significante entre a sensação do zumbido pela escala EVA e a postura craniocervical em professores (p <0,001). Também foi encontrada associação entre a queixa de zumbido e a amplitude de movimento com rotação para a direita, sendo que a idade e a inclinação lateral para a direita são fatores independentes no que se refere a sensação de zumbido em professores. Na correlação do THI (total e domínios) apenas a inclinação à esquerda apresentou associação com a mobilidade cervical. Conclusão: os resultados da pesquisa demonstraram correlação entre a sensação e repercussão do zumbido na qualidade de vida e postura craniocervical em professores, apontando que estes aspectos devem ser considerados na avaliação de professores com zumbido, além de que, são necessários mais estudos com população de professores, adultos saudáveis, com intuito de ampliar o conhecimento sobre o assunto.